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DT1 Exam 2 > Ortho > Flashcards

Ortho Flashcards

1
Q

osteoarthritis

A

progressive, irreversible condition involving loss of articular cartilage

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2
Q

associations of osteoarthritis

A

age
obesity
trauma

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3
Q

Heberden’s nodes

A

at DIP

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4
Q

Bouchard’s nodes

A

at PIP

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5
Q

x-rays of osteoarthritis

A

loss of joint space
slcerosis
subchondral cysts
osteophytes

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6
Q

symptoms of osteoarthritis

A

stiffness, pain, deformity

worse at end of day, in groin for hip OA

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7
Q

treatment of osteoarthritis

A 
weight loss
PT
bracing
glucosamine/chondroitin
NSAIDs
cymbalta
steroid injection
viscosupplementation-gel for lubrication to increase protein
arthroscopic debridement
joint replacement
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8
Q

rheumatoid arthritis

A

autoimmune disorder with inflammatory synovitis that destroys cartilage
symmetrical distribution of joints

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9
Q

requirements for RA

A 
morning stiffness
arthritis of 3 joints for 6 weeks
systemic arthritis for 6 weeks
rheumatoid nodules
\+RF factor
radiographic changes
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10
Q

clinical findings for RA

A

joint contractures, effusions, deformity
ulnar deviation of hands
PIP and MCP inflammation
elevated ESR and CRP

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11
Q

rheumatoid factor

A

IgM antibodies against Fc portion of IgG

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12
Q

RA HLA

A

DR4

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13
Q

treatment RA

A

NSAIDs
steroids
DMARDs-hydroxychloroquine, methotrexate, gold, Embrel
surgery

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14
Q

septic arthritis

A

infection in the joint

most common in kids from hematogenous spread

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15
Q

cause of permanent damage in septic arthritis

A

metalloproteases

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16
Q

symptoms of septic arthritis

A

fever, tachycardia

pain with ROM

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17
Q

clinical findings for septic arthritis

A 
slight flex in joint
passive ROM is painful
elevated or normal WBC
joint aspirate >50k WBC
elevated ESR, CRP
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18
Q

septic arthritis in neonate

A

staph aureus

GBS

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19
Q

<5yo septic arthritis

A

staph aureus
GAS
h flu
strep pneumo

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20
Q

septic arthritis in adolescents

A

gonorrheoeae

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21
Q

septic arthritis in adults

A

staph aureus

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22
Q

septic arthritis in sickle cell patients

A

salmonella

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23
Q

chronic septic arthritis

A

TB or lyme

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24
Q

treatment of septic arthritis

A

surgical washout

antibiotics immediately

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25
Q

ankylosing spondylitis

A

uveitis, carditis, enthesitis (inflammation of attachment of tendons)

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26
Q

HLA in ankylosing spondylitis

A

HLA-B27

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27
Q

Reiter disease

A

after urethritis, cervicitis, dysentery

reactive arthritis 2-8 weeks after infection

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28
Q

psoriatic arthritis

A

nail disorders

iritis

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29
Q

IBD

A

more seronegative spondyloarthropathies in Chrons

HLA-B27

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30
Q

symptoms of seronegative spondyloarthropathies

A

back pain and morning stiffness

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31
Q

exam for seronegaive spondyloarthropathies

A

FABER (flexion, abduction, external rotation) tests SI joint

enthesitis

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32
Q

treatment for seronegative spondyloarthropathies

A

NSAIDs
MTX
surgery

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33
Q

MSK tumors derivation

A

mesodermal tissue

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34
Q

mets from MSK tumors

A

to lung

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35
Q

most common carcinomas to met to bone

A 
prostate
lung
breast
thyroid
renal
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36
Q

bone tumors in people over age of 40

A

most likely metastatic

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37
Q

treatment benign soft tissue

A

if >5cm or deep-excision

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38
Q

treatment malignant soft tissue

A

resection, chemo, radiation

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39
Q

treatment benign bone

A

excision if aggressive

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40
Q

treatment malignant bone

A

chemo, resection, reconstruction, radiation

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41
Q

location of osteomyelitis

A

metaphysis

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42
Q

most common bacterial cause of osteomyelitis

A

staph aureus

hemolytic strep, TB, syphillis, fungus, virus

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43
Q

presentation of osteomyelitis

A

achy, unrelenting night pain
fever
ROM is ok
swelling, warmth, redness, draining sinus

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44
Q

tests for osteomyelitis

A

elevated WBC with left shift
elevated inflammatory markers
Brodie’s abscess

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45
Q

treatment of osteomyelitis

A

treatment with Vanc
surgical washout if no improvement in 2 days
may need to occur multiple times for diabetic patients

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46
Q

osteoporosis

A

low bone mass leading to microarchitectural deteriorization, causing increase fragility of bone

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47
Q

primary type 1 osteoporosis

A

postmenopausal

caused by hormonal changes leading to bone loss

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48
Q

primary type 2 osteoporosis

A

senile

caused by altered calcium metabolism leading to bone loss

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49
Q

secondary osteoporosis

A 
long term steroid use
hyperparathyroidism
hyperthyroidism
renal failure
cancers
connective tissue diseases
long term immobilization
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50
Q

exam osteoporosis

A

loss of height

thoracic kyphosis

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51
Q

T score

A

compared to 25 yo

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52
Q

Z score

A

compared to age matched peer

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53
Q

prevention of osteoporosis

A

maximize Ca/Vit D and weight bearing exercise before 30

minimize smoking, caffeine, meds

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54
Q

treatment of osteoporosis

A

bisphosphonates
calcitonin
pulsed PTH

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55
Q

classic presentation chondrosarcoma

A

tooth achy pain
over 50
dots of calcification
hypocellular and bluish

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56
Q

histology of metastatic disease

A

epithelial (cuboidal cells)

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57
Q

radio-opaque

A

bones
some soft tissues
harware

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58
Q

radio-lucent

A

air
sutures
ligaments

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59
Q

minimum xray

A

2 views at 90 degrees

xray joint above and below injury

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60
Q

most energy for fracture

A

comminuted fracture

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61
Q

least energy for fracture

A

spiral fracture

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62
Q

least tolerated leading to malunion

A

rotation

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63
Q

RANK pathway

A

RANKL on OB and marrow stroma cells

RANK receptor on OC-allows OC generation and survival

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64
Q

M-CSF pathway

A

M-CSF secreted by OB

M-CSF receptor allows OC generation and survival

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65
Q

WNT/B catenin pathway

A

WNT from marrow stromal cells
LRP5/6 OB receptor bind WNT protein
secrete OPG to block RANK

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66
Q

bone composition

A

calcium hydroxyapatite

organic matrix mostly type 1 collagen

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67
Q

woven bone

A

random collagen
resists forces in all directions
pathologic in adult
rapid bone growth-healing

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68
Q

lamellar bone

A

ordered collagen-can be compact or spongy
replaces woven bone
stronger than woven bone

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69
Q

osteopontin

A

unique to bone

levels parallel osteoblast activity

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70
Q

alkaline phosphatase

A

from osteoblasts

also in liver and placenta

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71
Q

bone formation

A

intraamembranous ossification
direct from mesenchyme
appositional growth

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72
Q

epiphysis

A

distal to growth plate

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73
Q

metaphysis

A

beneath growth plate

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74
Q

diaphysis

A

center

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75
Q

dysostosis

A

local problems in migration of mesenchyme and their condensation

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76
Q

brachydactyly

A

HOXD13

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77
Q

dysplasia

A

global defect in regulation of skeletal organogenesis

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78
Q

cleidocranial dysplasia

A

short stature
abnormal clavicles
supernumery teeth
wormian bone

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79
Q

genetic cleidocranial dysplasia

A

RUNX2

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80
Q

achondroplasia

A

growth plate defect from paracrine cell defect

reduced chondrocyte proliferation in growth plate

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81
Q

genetic achondroplasia

A

FGFR3 gain of function

inhibits cartialge growth

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82
Q

bone histology in achondroplasia

A

growth plates are narrowed and disorganized-premature bone deposition
appositional and intramembranous bone formation continues-creates thick cortical bone

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83
Q

characteristics of achondroplasia

A 
short stature
short proximal limbs
normal trunk length
enlarged head with bulging forehead
depression root of nose
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84
Q

most common lethal dwarfism

A

thanatophoric dwarfism

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85
Q

genetic thanatophoric dwarfism

A

FGFR3 gain of function

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86
Q

characteristics of thanatophoric dwarfism

A

micromelic short bowed limbs
frontal bossing with macrocephaly
small underdeveloped chest and bell shaped abdomen-respiratory failure

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87
Q

gain of function LRP5

A

osteopetrosis

autosomal dominant osteopetrosis type 1

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88
Q

osteoporosis pseudoglioma syndrome

A

inactivate LRP5
skeletal fragility
loss of vision

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89
Q

defects in osteopetrosis

A

cannot acidify pit-CA2 deficiency
defect in RANKL
LRP5 gain of function

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90
Q

clinical osteopetrosis

A

extramedullary hematopoiesis
Erlenmeyer flask deformity
narrow neural foramina
Brittle bones

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91
Q

autosomal dominant benign osteopetrosis

A 
most common
multiple fractures
anemia
hepatosplenomegaly
mild cranial nerve defects
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92
Q

treatment of autosomal dominant benign osteopetrosis

A

treated with bone marrow transplant

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93
Q

osteogenesis imperfecta

A

type 1 collagen disease
mutation in alpha1 or alpha2
most common is autosomal dominant

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94
Q

characteristics of osteogenesis imperfecta

A 
blue sclerae
normal stature with less fractures after puberty
hearing loss from abnormal bone 
joint laxity
dentinogenesis
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95
Q

defect in hyaline cartilage

A

type 2, 9, 10, 11 collagen disease

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96
Q

mucopolysaccharidoses

A

defect in enzymes degrading dermatan sulfate, heparan sulfate, keratan sulfate
malformed bones
defect in hyaline cartilage

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97
Q

osteopenia

A

decrease bone mass

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98
Q

osteoporosis

A

osteopenia to the point of risk of fracture

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99
Q

low turnover osteoporosis

A

senile
reduced osteoblasts
cortex thinned on all surfaces
mostly hereditary-vitamin D receptor, collagen 1A1, estrogen receptor

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100
Q

high turnover osteoporosis

A

postmenopausal
increase in inflammatory cytokines
decrease OPG increase OC

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101
Q

causes of secondary osteoporosis

A 
hyperparathyroidism
neoplasia
multiple myeloma
vitamin D def
anticoagulants
corticosteroids
immobilization
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102
Q

test of choice for osteoporosis

A

dual-energy absorptiometry

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103
Q

rickets

A

vitamin D deficiency in children

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104
Q

osteomalacia

A

vitamin D deficiency in adults

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105
Q

hyperparathyroidism

A

PTH excess

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106
Q

renal osteodystrophy

A

chronic renal disease

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107
Q

most common cause of primary hyperparathyroidism

A

adenoma (parathyroid adenoma)

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108
Q

findings from hyperparathyroidism

A

loss radial aspect of middle phalanges
osteopenia
Brown tumor

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109
Q

brown tumor

A

bone replaced by fibrovascular tissue

granulation tissue and hemosiderin

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110
Q

severe hyperparathyroidism

A

osteitis fibrous cystica

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111
Q

findings in renal osteodystrophy

A

hyperparathyroidism
decreased 1,25 D
metabolic acidosis due to increase release of Ca

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112
Q

most common sites for Paget

A

axial skeleton and proximal femur

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113
Q

osteolytic stage of Paget

A

loss of bone mass

osteoclasts resorption in pits

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114
Q

mixed stage of Paget

A

osteolytic and osteoblastic

prominant osteoblast and osteoclast

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115
Q

osteosclerotic stage of Paget

A

coarse irregular trabeculae

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116
Q

histo of Paget

A

mosaic pattern of lamellar bone

jigsaw puzzle-like cement lines

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117
Q

clinical presentation Paget

A 
often incidental
increase Alk Phos
normal Ca and PO4
cranial nerve palsy
heavy skull
severe secondary osteoarthritis
chalk stick-type fracture
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118
Q

benign tumors in paget

A

giant cell

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119
Q

malignant tumors in paget

A

osteosarcoma and fibrosarcoma

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120
Q

treatment for paget

A

calcitonin and bisphosphonates

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121
Q

high output cardiac failure in paget

A

warm skin-hypervascularity

can create AV shunting

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122
Q

procallus-soft tissue callus

A

hematoma fibrin creates framework
OPG activated
no rigidity, easily disrupted

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123
Q

boney callus

A

woven bone
cartilage for enchondral ossification
max girth at 3 weeks
over time remodels

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124
Q

complications of fracture

A

misaligned bone
infected, displaced or devitalized bone leads to deformity
pseudoarthrosis from nonunion

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125
Q

osteonecrosis

A

infarction of bone and marrow
dead bone/fat replaced by Ca soaps
creeping substitution-slow bone growth
continued fractures and slough articular cartilage

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126
Q

most common cause of osteonecrosis

A

corticosteroids

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127
Q

other causes of avascualar necrosis

A 
corticosteroids
idiopathic
infection
dysbarism
pregnancy
sickle cell disease
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128
Q

medullary infarct in avascular necrosis

A

geographic necrosis

painful if large

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129
Q

subchondral infarct in avascular necrosis

A

chronic pain
wedge-shaped subchondral bone
tends to lead to osteoarthritis

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130
Q

bacteria reach bone in osteomyelitis

A

hematogenous (most common in children)
direct extension
implantation

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131
Q

cray of osteomyelitis

A

lytic bone lesion with surrounding sclerosis

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132
Q

pyogenic osteomyelitis in neonate

A

metaphysis or epiphysis

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133
Q

pyogenic osteomyelitis in child

A

metaphysis

with subperiosteal abscess

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134
Q

pyogenic osteomyelitis in adult

A

epiphyses and subchondral bone

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135
Q

sequestrum

A

dead piece of bone

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136
Q

brodie abscess

A

small intraosseous abscess in cortex walled off by reactive bone

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137
Q

sclerosing osteomyelitis of Garre

A

in jaw with extensive new bone formation

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138
Q

cancer from pyogenic osteomyelitis

A

SCC

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139
Q

Pott disease

A

break through discs to other vertebrae
scoliosis and kyphosis
from TB
knees and hips second most common

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140
Q

syphilis of bone

A

T pallidum and T pertenue

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141
Q

congenital syphilis

A

to enchondral ossification centers (osteochondritis) and periosteum (periostitis)

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142
Q

acquired syphilis

A

bone in tertiary phase

saddle nose, saber shin, palate, skull, vertebrae, hands/feet

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143
Q

most common benign tumors

A

osteochondroma

fibrous cortical defect

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144
Q

most common malignant tumor

A

osteosarcoma

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145
Q

tumors of epiphysis

A

clear cell chondrosarcoma

chondroblastoma

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146
Q

tumors of diaphysis

A

Ewing sarcoma

fibrous dysplasia

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147
Q

tumors of epiphysis/metaphysis

A

giant cell tumor

aneursymal bone cyst

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148
Q

common locations of osteoma

A

sinuses, skull, face

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149
Q

Gardner syndrome

A

multiple osteomas
intestinal polyps
epidermal cysts
fibromatosis

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150
Q

osteoid osteoma location

A

metaphysis
femur/tibia
humerus/hands/feet

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151
Q

xray of osteoid osteoma

A

central nidus

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152
Q

characteristics of osteoid osteoma

A

painful at night

NSAID relief

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153
Q

common location of osteoblastoma

A

vertebrae posterior

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154
Q

characteristics of osteoblastoma

A

dull ache

no relief from NSAID

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155
Q

most common nonhematopoetic malignant bone tumor

A

osteosarcoma

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156
Q

ages for osteosarcoma

A

early (knee)
elderly (Paget, flat and long bones)
presents as painful enlarging mass

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157
Q

most common osteosarcoma

A

primary, solitary, long bone (knee)
metaphysis medulla
poorly differentiated with boney matrix

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158
Q

xray of osteosarcoma

A

mixed lytic and blastic
breaks through cortex
Codman traingle
may have chondroid element

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159
Q

osteosarcoma metastasis sites

A

lungs, bones, brain

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160
Q

genetics osteosarcoma

A

RB

p53 (LiFraumeni)

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161
Q

osteochondroma

A

mushroom shaped cartilage capped
adolescence early adult
stop growing with closure of growth plate

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162
Q

most common location of osteochondroma

A

long tubular bones (knee)

metaphysis

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163
Q

genetic osteochondroma

A

multiple hereditary exostosis

EXT1 or EXT2

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164
Q

chondroma

A

benign hyaline cartilage tumors

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165
Q

enchondroma

A

medullary cavity
age 20-50
nodules of hyaline cartilage with peripheral enchondral ossification

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166
Q

most common site of enchondroma

A

hands and feet

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167
Q

most common intraosseous cartilage tumor

A

enchondroma

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168
Q

subperiosteal chondroma

A

surface of bone

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169
Q

increased sarcoma transformation

A

enchondromatosis (Ollier disease)

Maffucci syndrome-enchondromas with hemangiomas

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170
Q

xray of enchondroma

A

well circumscribed lucency with a thin rim of dense bone

looks like soap bubbles

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171
Q

most common bone tumor of phalynx

A

enchondroma

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172
Q

most common location for chondroblastoma

A

knee epiphyses

seen in teenagers

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173
Q

most common type of chondrosarcoma

A

conventional (hyaline and/or mixed)

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174
Q

location for chondrosarcoma

A

pelvis, shoulder, ribs

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175
Q

location of clear cell chondrosarcoma

A

long tubular bone epiphyses

occurs in teens (along with mesenchymal)

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176
Q

x ray conventional chondrosarcoma

A

nodular growth with endosteal scalloping and flocculent densities from calcification
reactive thickened cortex bone

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177
Q

conventional chondrosarcoma sites of metastasis

A

lungs and bone

178
Q

location of fibrous cortical defect

A

metaphysis of knee

resolves into normal bone

179
Q

location of nonossifying fibroma

A

metaphysis of knee

persists

180
Q

patterns of fibrous dysplasia

A

monostotic
polyostotic with soft tissue myxomas
polyostotic with endocrine dysfunction

181
Q

xray of fibrous dysplasia

A

ground glass and well demarcated border

182
Q

location fibrous dysplasia

A

metaphysis or diaphysis

183
Q

locations of monostotic fibrous dysplasia

A

ribs, femur, tibia, jaws, calvaria and humerus

184
Q

characteristics of McCune-Albright Syndrome

A

Cafe au lait skin pigmentations
endocrine-sexual precocity (often presenting)
hyperthyroidism, pituitary adenomas with GH, primary adrenal hyperplasia

185
Q

genetic basis of fibrous dysplasia

A

hyperactive G protein

GNAS gene

186
Q

histology of fibrous dysplasia

A

chinese character woven bone in fibrous stroma

187
Q

risk for fibrous dysplasia to become malignant

A

increased if polyostotic

increased if irradiated

188
Q

characteristics of ewing sarcoma

A

small round (blue) cell tumor
glycogen
Homer-Wright rosettes

189
Q

genetic EWS

A

t(11;22) EWS-FLI1

190
Q

EWS on xray

A

lytic destruction with onionskin periosteal reaction and sunburst pattern

191
Q

giant cell tumor of bone

A

benign locally aggressive tumor of macrophage/monocyte system
hemosiderin

192
Q

location of giant cell tumor

A

epiphyses but may extend into metaphysis

193
Q

most common location of giant cell tumor of bone

A

knee

194
Q

xray giant cell tumor

A

lytic excentric eroding into subchoroidal bone plate

195
Q

aneurysmal bone cyst

A

multiloculated blood-filled cysts

196
Q

location for ABC

A

metaphysis of long bones and vertebrae

pain and swelling

197
Q

xray for ABC

A

eccentric, expansile and well-demarcated

198
Q

histology for ABC

A

blood filled cysts separated by internal septae
woven bone
fluid levels

199
Q

most common form of skeletal malignancy

A

metastatic disease

200
Q

sclerotic bone metastasis

A

prostate

201
Q

cancers metastatic disease

A 
prostate
kidney
breast
lung
thyroid
202
Q

common location in met disease

A

axial skeleton

203
Q

pediatric metastatic disease

A 
neuroblastoma
Wilms tumor
osteosarcoma
Ewing sarcoma
Rhabdomyosarcoma
204
Q

osteoarthritis in men

A

hips

205
Q

osteoarthritis in women

A

knees and hands

206
Q

primary osteoarthritis

A

from aging

207
Q

secondary osteoarthritis

A

repeated injuries to joint
hemochromatosis
obesity

208
Q

phases of osteoarthritis

A

chondrocyte injury
chondrocyte proliferation
chondrocyte drop out with loss of cartilage

209
Q

osteophytes

A

extra bone at joint edge

210
Q

characteristics of osteoarthritis

A 
deep achy pain
morning stiffness
worse with use
crepitus of joint
limited range of motion
vertebral impinge on nerve roots
211
Q

cysts in osteoarthritis

A

subchondral cysts of synovial fluid

212
Q

joint mice

A

loose bodies of cartilage

213
Q

pannus

A

exuberant inflamed synovium
mostly CD4 T cells, B cells, plasma cells, macrophages
granulation tissue with hemosiderin
erodes cartilage
erodes bone-juxtarticular cysts, subchondral cysts, osteoporosis

214
Q

RF

A

autoAb against Fc portion or IgG (not specific)

215
Q

more specific for RA

A

Ab to citrullin modified peptides (anti-cyclic citrullinated peptide)

216
Q

synovial fluid in RA

A

high protein content
low mucin content
inflammation

217
Q

clinical RA

A

symmetric with small joints before large
PIP, MCP
joints-warm, swollen, painful and stiff with inactivity
radial deviation of wrist, ulnar deviation of fingers
flexion-hyperextension of fingers (boutonniere)
synovial cysts-Baker cyst

218
Q

rheumatoid nodules

A

most common cutaneous manifestation
found in areas subject to pressure-ulnar aspect of forearm, elbows, occiput, lumbosacral
fibrinoid necrosis surrounded by macrophages

219
Q

vasculitis in RA

A

does not involve kidneys

can be obliterative endarteritis of vasa nervorum and digital arteries

220
Q

leukocytoclastic venulitis

A

purpura, skin ulcers, nail bed infarction

221
Q

juvenile idiopathic arthritis

A

before 16 and present 6 weeks
oligoarticular, polyarticular, systemic
large joints

222
Q

associated symptoms for juvenule idiopathic arthritis

A

pericarditis, myocarditis, pulmonary fibrosis, uveitis, glomerulonephritis, growth retardation

223
Q

JIA differ from RA

A 
oligoarthritis
systemic
large joints
no RF or nodules
may be ANA positive
224
Q

JIA same as RA

A

pannus formation

morphology of involved joints

225
Q

ankylosing spondyloarthritis

A

HLAB27
sacroiliac joint
M>F
inflammation of tendon/ligament insertion

226
Q

complications of ankylosing spondyloarthritis

A

uveitis
aortitis
amyloidosis
spine fractures

227
Q

reactive arthritis

A

after infection (Chlamydia, shigella, salmonella)
triad-arthritis, urtehritis, conjunctivitis
ankles, knees, feet in asymmetric pattern
sausage toe or finger from digital tendon sheath synovitis

228
Q

extra-articular reiter

A

balanitis
conjunctivitis
heart conduction defects
aortic regurgitation

229
Q

enteritis associated arthritis

A

yersinia, salmonella, shigella, campylobacter
LPS stimulates response
only arthritis in knees and ankles

230
Q

genetic psoriatic arthritis

A

HLA-B27 and HLA-Cw6

231
Q

findings in psoriatic arthritis

A

asymmetric in DIP of hands/feet-pencil in cup deformity
can affect large joints
can cause sacroiliac and spine disease

232
Q

extra-articular psoriatic arthritis

A

conjunctivitis

iritis

233
Q

infectious arthritis

A 
bacteria always suppurative
hematogenous spread
<2 h flu
elderly and children staph
sickle salmonella
adolescent gonococcus F>M
234
Q

predisposing conditions for infectious arthritis

A 
immunodeficiency
abnormal joint
debilitation
IV drug use (axial joints)
arthritis
235
Q

TB infectious arthritis

A

monarticular from adjacent osteomyelitis or hematogenous spread
vertebrae, hips, knees ankles

236
Q

viral causes of infectious arthritis

A

parvo B19
HCV, HBV
HIV

237
Q

lyme diseae infectious arthritis

A

2 weeks to 2 years after bit
remitting/migratory arthritis in large joints (knees>shoulders>elbows>ankles)
chronic synovitis with organisms near vessels

238
Q

gout

A

uric acid from purine metabolism

arthritis from monosodium urate

239
Q

tophi

A

mass deposits of urates

macrophages, lymphocytes, giant cells

240
Q

negative birefringent

A

gout

241
Q

primary gout

A

most unknown

known enzyme defects (HGPRT)

242
Q

secondary gout

A

increased nucleic acid turnover (AML)

chronic renal disease

243
Q

conditions for monosodium urate precipitation

A

lower temperatures

lower pH

244
Q

gout phases

A

asymptomatic hyperuricemia
acute arthritis (most first MTP)
intercritical gout-no symptoms
chronic tophaceous gout

245
Q

tophaceous arthritis

A

inflammation destroys synovium, joint and adjacent bone

joints and periarticular tissue

246
Q

risk factors for primary gout

A 
>30 yo
genetic predisposition
heavy drinking
obesity
drugs (thiazides)
Pb toxicity
247
Q

calcium pyrophosphate crystal deposition disease

A

knee>wrist
usually asymptomatic
crystals first seen in articular matrix, menisci, and intervertebral disc

248
Q

positive birefringent

A

CPPD

249
Q

chalky white deposits

A

CPPD

250
Q

risk factors for CPPD

A

hereditary
idiopathic
secondary from joint damage, hyperparathyroidism, hypothyroidism, hemochromatosis, diabetes

251
Q

ganglion cyst

A

near joint or tendon sheath
cytotoxic or myxoid degeneration of tissue
no communication with joint space

252
Q

most common site of ganglion cyst

A

wrist

253
Q

synovial cyst

A

connected to joint capsule or bursa

254
Q

baker cyst

A

popliteal synovial cyst often in setting of RA

255
Q

genetic tenosynovial giant cell tumor

A

t(1;2) express CSF-1 to attract macrophages

256
Q

tenosynovial giant cell tumor

A

diffuse-pigmented villonodular
localized-giant cell tumor
macrophages and giant macrophage cells
hemosiderin and lipid vacuoles

257
Q

pigmented villonodular synovitis

A 
joint synovium diffusely affected
red/born to yellow from hemosiderin
freq knee
locking or swellin
lush villous surface
258
Q

localized tenosynovial giant cell tumor

A

often attached to synovium or tendon

slow growing painless

259
Q

most common soft tissue tumor of hand

A

localized tenosynovial giant-cell tumor

260
Q

cubital tunnel syndrome

A

compression of ulnar nerve at elbow

numbness and tingling to 4th and 5th digits

261
Q

clinical findings for cubital tunnel syndrome

A

EMG shows 30% velocity reduction

262
Q

treatment cubital tunnel syndrome

A

behavior modification

surgical transposition

263
Q

carpal tunnel syndrome

A

compression of median nerve at the wrist

numbness and tingling to 1-3rd digits

264
Q

treatment carpal tunnel syndrome

A

night splints, steroid injections, carpal tunnel release

265
Q

trigger finger

A

inflammation of flexor tendon gets snapping through pulleys in hand
catching of finger when actively flexing finger

266
Q

physical findings of trigger finger

A

palpable knot moves with tendon at distal palm

267
Q

treatment trigger finger

A

NSAID
steroid injections
A1 pulley release

268
Q

mallet finger

A

laceration of extensor tendon at base of DP

inability to straighten finger tip

269
Q

xray mallet finger

A

may show avulsion fracture at base of DP

270
Q

de quervain tenosynovitis

A

swelling and inflammation of tendons that run through 1st dorsal compartment (APL, EPB)
pain over radial styloid

271
Q

exam for de quervain

A

Finklestein’s test

272
Q

treatment for de quervain

A

splint, NSAIDs, steroid injection, release of compartment

273
Q

dupuytren disease

A

nodular thickening of palmar fascia (N. Europeans)
painless nodules that draw 4th and 5th digits
cords may form, causing flexion of digits, table top test

274
Q

treatment of dupuytren disease

A

splinting, collagenase injections, fasciotomies

275
Q

low back pain

A

80% no cause
radiates to buttocks
reflexes and neuro normal

276
Q

testing low back pain

A

no testing for 6 weeks unless atypical pain
xray
MRI

277
Q

treatment low back pain

A

NSAIDs
no bedrest
PT

278
Q

herniated nucleus pulposis

A

extrusion of center of disc posteriorly compressing nerve roots

279
Q

site of nucleus pulposis

A

L4-L5

L5-S1

280
Q

symptoms of herniated nucleus pulposis

A

abrupt unilateral radicular pain, worse with activity

281
Q

exam herniated nulceus pulposis

A

straight leg raise, dermatomal weakness and parasthesias

282
Q

spondylolisthesis

A

forward slippage of lumbar vertebral body

back pain when bending

283
Q

exam spondylolisthesis

A

dermatomal weakness, may feel spinous process stepoff

284
Q

tests spondylolisthesis

A

flex/extension xrays of spine show slippage

285
Q

treatment spondylolisthesis

A

NSAID

surgical fusion

286
Q

spondylosis

A

degenerative changes in facets or discs leading to osteophytes and possible nerve compression
radicular or myelopathy may be present

287
Q

tests spondylosis

A

MRI can show pinched nerves

288
Q

treatment spondylosis

A 
NSAIDs
steroids
traction
surgical decompression
fusion
289
Q

C5 myotome

A

deltoid

290
Q

C6 myotome

A

biceps, wrist extensors

291
Q

C7 myotome

A

triceps, wrist flexors

292
Q

C8 myotome

A

finger flexors

293
Q

T1 myotome

A

interossei

294
Q

DISH

A

idiopathic disease characterized by osteophyte formation spanning several vertebra
xray shows osteophytes over 4 vertebra

295
Q

treatment DISH

A

NSAIDs

296
Q

radiculopathy

A

compression of nerve root
unilateral radiating dermatomal pain
ROM causes radiating pain, dermatomal weakness and parasthesias, no UMN signs

297
Q

treatment radiculopathy

A

NSAIDs, steroid injections, PT traction, surgical decompression

298
Q

myelopathy

A

compression of spinal cord
bilateral weakness, difficulty with fine motor tasks, wide based gait
bowel and bladder dysfunction, UMN signs

299
Q

myelopathy

A

epidural injections may help but surgical

300
Q

ACL tear

A

primary stabilizer of knee preventing anterior tibial translation
popping sound, hemarthrosis, knee instability
50% meniscal tear

301
Q

exam ACL tear

A

positive Lachman

positive anterior drawer

302
Q

treatment

A

PT for hamstring strength

ACL reconstruction if unstable

303
Q

frozen shoulder

A

idiopathic loss of shoulder motion, associated with Diabetes
early freezing
painful delt insertion
loss of 50% active and passive ROM

304
Q

treatment frozen shoulder

A

NSAIDs, injections, ROM with PT

arthroscopic lysis of adhesions and manipulation under anesthesia

305
Q

impingement syndrome

A

inflammation of subacromial bursa and rotator cuff tendons in middle aged
lateral pain with overhead activity
MRI may show inflammation

306
Q

exams impingement syndrome

A

positive hawkins, supraspinatous test, no weakness

307
Q

treatment impingement syndrome

A

PT
steroid injection into subacromial space
surgical decompression

308
Q

elbow epiconylitis

A

degenerative painful condition of the ECRB tendon and/or flexor-pronators

309
Q

exam elbow epiconylitis

A

pain when resisted extension with forearm pronated (lateral) or flexion (medial)

310
Q

treatment elbow epiconylitis

A

tennis elbow strap, ice, larger grips, PT, NSAIDs
steroid injection
surgical debridement

311
Q

meniscal tear

A

fraying or tear of menisci

locking and catching in the knee

312
Q

exam meniscal tear

A

McMurrays positive

joint line tenderness

313
Q

treatment meniscal tear

A

PT

arthroscopic debridement

314
Q

olecranon bursitis

A

inflammation of olecranon bursa
related to gout
swelling of posterior elbow

315
Q

test olecranon bursitis

A

aspiration for crystals and infection

316
Q

treatment olecranon bursitis

A

NSAIDs for acute, ice

surgical removal

317
Q

patellofemoral pain

A

pain around patella without signs of arthritis, common in teenagers during growth spurt
anterior knee after sitting or climbing stairs

318
Q

exam patellofemoral pain

A

Q angle
patellar apprehension
resisted extension of knee

319
Q

treatment patellofemoral pain

A

PT for quad strength

320
Q

plantar fasciitis

A

degenerative tear of plantar fascia, more common in women and overweight persons with tight gastroc-soleus tendons
worse in AM, insidious onset

321
Q

exam plantar fasciitis

A

tender on medial and lateral calcaneous, tight dorsiflexion

322
Q

heel spur in plantar fasciitis

A

not cause of pain

323
Q

treatment plantar fasciitis

A

NSAIDs, heel cups, stretches of heel cord
injections
surgical release

324
Q

rotator cuff tear

A

tear of supraspinatous most common, infraspinatous, subscapularis, or teres minor
acute in young, chronic in older
pain with overhead activity, catching or grating sensation

325
Q

exam rotator cuff tear

A

positive drop arm, hawkins, weak supraspinatous, weak external rotation

326
Q

treatment rotator cuff tear

A

PT, NSAIDs

repair of tendons-arthroscopically or open

327
Q

rupture of proximal biceps tendon

A

rupture of long head of biceps with labral injury
sudden pain, bulge in arm
pain with supination

328
Q

treatment rupture of proximal biceps tendon

A

NSAID, PT

occassionally tenodesis

329
Q

trochanteric bursitis

A

inflammation of greater trochanteric bursa from tight IT bands
lateral hip pain, unable to lie on side

330
Q

exam trochanteric bursitis

A

point tender over posterior GT
Ober test
MRI shows swelling of bursa

331
Q

treatment trochanteric bursitis

A

NSAIDs

PT for stretches and strengthening

332
Q

nonunion def

A

failure of fracture to heal

333
Q

open fracture def

A

break in overlying skin that leads to direct communications between the fractured bone and environment-leads to contamination and potential for infection

334
Q

long bone def

A

femur, tibia, humerus, forearm

335
Q

intraarticular fracture def

A

any fracture around joint with extension of the fracture into the joint space

336
Q

compartment syndrome

A

rise of interstitial pressure within a defined space resulting n a failure of perfusion at the microvascular level causing ischemia of the myoneural tissue
-with or without fracture, in the leg, emergency

337
Q

symptoms compartment syndrome

A

intractable pain with tense limb
pain out of proportion with specific and active motion
pulses and capillary refill are not an indicator of compartment syndrome

338
Q

absolute emergencies

A

vascular compromise
dislocations with NV compromise
hip fractures in the young
compartment syndrome

339
Q

relative emergencies

A

femur fractures
dislocations without NV compromise
pediatric elbow fractures without NV compromise (supracondylar)

340
Q

urgencies

A

supracondylar elbow
geriatric hip fractures where hip replacement is treatment
tibia fracture

341
Q

open fracture treatment

A

start antibiotics before leaving OR (cefazolin first line)
surgical debridement
stabilization (ex-fix or ORIF)

342
Q

5 P of ischemia

A 
pain
palor
parasthesia
pulse (less)
poikilothermia
343
Q

4 C of muscle viability

A

color
contractility
consistency
capacity to bleed

344
Q

scapula fracture

A

high energy marker

associated injuries-rib fractures, great vessel injury, brachial plexus injury, pulm/card contusion, pneumo/hemothorax

345
Q

clavicle fracture

A

risk of mal/nonunion

surgery if severely displaced or shortened

346
Q

humerus fracture

A

acute-radial nerve injury
chronic-nonunion
ORIF only if polytrauma, displaced, nonunion and NV compromise

347
Q

forearm fracture

A

acute-compartment or NV compromise

chronic-functional loss from poor reduction

348
Q

pelvis/acetabulum fracture

A

marker for high energy trauma
acute-bleeding
long term-DJD, sciatic nerve/lumbar/sacral plexus
operative with displacement or instability

349
Q

femur fracture

A

marker for high energy trauma
acute-cardio-pulm compromise
nonunion, pain, infection
ex fix, traction, IMN

350
Q

tib/fib fracture

A

acute-open, compartment, NV compromise
chronic-mal-nonunion, osteomyelitis
stable patterns can be casted

351
Q

low energy mechanisms

A 
FOOSH
elderly hip fracture
LC-1 pelvic ring fracture falling from standing height
elbow or proximal humerus fracture
"knee fractures"
352
Q

trauma evaluation

A 
airway-spekaing
breathing-intubate
circulation-stable BP
disability-move extremities
expose-clothes come off
353
Q

good ortho exam

A

palpate every join in upper and lower extremity

rock the pelvis and check the scapula

354
Q

distracting injury

A

cannot clear c-spine in fracture of extremity

355
Q

xray in ortho trauma

A

gold standard
always get joint above or below fracture
joint fractures get CT and so does pelvis/acetabulum

356
Q

xray routine in ortho trauma

A 
C-spine
CXR
A/P pevis
acetabulum-judet views with rotation
pelvic ring-inlet/outlet views
357
Q

pelvis fractures more dangerous

A

open-hemorrhage is concern

358
Q

peroneal branch injury

A

posterior hip dislocations
proximal fibula
foot drop

359
Q

tibial branch injury

A

knee dislocations

360
Q

femoral nerve

A

antigravity muscles
damaged in penetrating trauma and iatrogenically
anterior hip dislocation

361
Q

common patterns for abuse

A

unwitnessed spiral fractures
fractures prior to walking age
rib fractures-most common
femur fractures

362
Q

suspect patterns for abuse

A 
multiple posterior rib
bucket handle fractures
multiple at diff stages of healing
long spiral fractures
long bone fractures in non-ambulatory
any femur fracture
363
Q

ddx with abuse

A

osteogenisis imperfecta

infantile disease cortical hyperostosis (Caffey’s disease)

364
Q

fractures not usually from abuse

A 
toddler fracture of tibia
torus or buckle wrist fracture
crushed fingers
nurse maids elbow
skull fracture in ambulatory child
365
Q

ligament

A

bone to bone supporting joint

366
Q

itis

A

inflammation

367
Q

sprain

A

injured ligament

368
Q

strain

A

muscle/tendon injury

369
Q

passive stabilizers of shoulder

A

labrum (increase depth)

glen-humeral ligament (thickening of labrum)

370
Q

dynamic stabilizers of shoulder

A

involves muscle
rotator cuff
scapular rotators

371
Q

separated shoulder

A

acromio-clavicular joint

fall directly onto shoulder

372
Q

dislocated shoulder

A

glen-humeral joint

mostly anterior dislocation

373
Q

rotator cuff tendinitis

A

overuse injury

conservative treatment-rest, NSAID, rehab

374
Q

tennis elbow

A

lateral wrist extensors

375
Q

golfers elbow

A

medial wrist flexors

376
Q

first degree sprain

A

minor
ligament intact
no laxity
mild local pain and swelling

377
Q

second degree sprain

A

partial tear
some laxity
local pain, swelling and ecchymosis

378
Q

third degree sprain

A

complete tear
significant laxity
ecchymosis and severe pain
repair

379
Q

common sports injuries lower limb

A

intracapsular or extracapsular sprain
meniscal tear
patella-femoral pain

380
Q

ACL injury

A

non-contact twisting injury
deceleration
hyperextension
pop or snap

381
Q

meniscal tear

A

rotation of flexed knee to extension
medial>lateral
commonly associated with other injuries

382
Q

high ankle sprain

A

syndosmotic

383
Q

achilles tendinitis

A

pain in achilles tendon
occasional swelling
must rule out partial tear

384
Q

classification of tears

A

longitudinal
horizontal
oblique
radial

385
Q

scoliosis

A

lateral curvature
girls 7x more liekly to progress
brace at >30; surgery at >40-50

386
Q

club foot

A 
idiopathic congenital foot deformity
plantar flexion of ankle
adduction of heel
high arch
adduction of forefoot
387
Q

club foot treatment

A

manipulation and casting immediately

surgery if still rigid at 3 yrs

388
Q

osgood schlatter

A

overuse injury causing apophyseal injury at tibilal tubercle

xray shows fragmentation of tubercle

389
Q

hip dysplasia

A

malformed hip socket and femoral head, associated with ligamentous laxity, left hip, female gender, preech

390
Q

treatment of hip dysplasia

A

barlow-dislocate

ortolani-put in

391
Q

perthes disease

A

idiopathic necrosis of femoral head (between 4-8 yo)

decreased internal rotation and abduction

392
Q

treatment of perthes disease

A

ROM and bracing

no good treatment (head blood from medial geniculate and pulvinar)

393
Q

slipped capital femoral epiphysis

A

displacement of femoral head through the physis usually during growth spurt
associated with obesity, males, sports, endocrine
loss of internal rotation with hip flexed
workup for endocrine if bilateral
surgical fixation

394
Q

treatment genu varum/valgum

A

observation
bracing
occassional epiphyseal stapling
osteotomy

395
Q

tarsal coalition

A

abnormal connection between tarsal bones
restricted hindfoot movement
xray shows calcaneal navicular coalition
cast and surgery

396
Q

transient synovitis of hip

A

sterile effusion of hip causing pain
groin pain, history of viral infection
gets better with NSAIDs
rule out septic arthritis

397
Q

supracondylar humerus fracture

A

most common elbow fracture

NV exam important

398
Q

xray for supracondylar humerus fracture

A

positive posterior sail sign

399
Q

rickets

A

error in vit D metabolism causing failure of mineralization

xray shows looser lines and widened growth plates, low normal ca, phos low

400
Q

hypertrophic zone in rickets

A

large

401
Q

growth in children

A

lower at knee

upper at shoulder and wrist

402
Q

acute joint effusion

A

mono articular
oligoarticular
systemic-JIA, lyme, septic

403
Q

cerebral palsy

A

permanent, non progressive brain injury in peripartum period

UMN affected with spasticity

404
Q

hemiplegia

A

one side

405
Q

diplegia

A

both sides

lower extremity

406
Q

warning signs for cerebral palsy

A

delayed motor development
history of prematurity
prolonged NICU stay
toe walking

407
Q

hypertrophic zone in achondroplasia

A

narrow

problems with spine

408
Q

marfan syndrome

A

fibrillin mutation

409
Q

orthopaedic emergency

A

open fractures-tetanus and ABx, surgical debridement

410
Q

high energy injuries

A

evaluate other limbs and spine for occult injuries

411
Q

stress fractures on xray

A

may take 1-4 weeks to show up

412
Q

MRI

A

nondisplaced femoral neck

413
Q

fracture principles

A

recognition
reduce
retain
rehab

414
Q

nonunion vs malunion

A

nonunion bone does not heal

malunion-unacceptable alignment

415
Q

primary healing

A

intramembranous
from rigid ifxation from plates
direct healing with no callous

416
Q

secondary healing

A

enchondral
controlled motion-rods and casts
indirect formation of bone from uncommitted mesenchymal cells

417
Q

stages of secondary healing

A

inflammatory
reparative for 8 weeks
remodeling for 1 year

418
Q

risk factors for nonunion

A 
lack of radiographic evidence of progression of callus formation over 3-5 month period
smoking
infection
poor immobilization
malnutrition
NSAID
poor blood supply
high energy trauma
419
Q

osteogenic bone graft

A

bone forming

only autologous bone graft contains viable osteoblasts

420
Q

osteoinductive bone graft

A

bone stimulation
encourages differentiation of mesenchymal cells into osteoblasts
BMP2/7

421
Q

osteoconductive bone graft

A

bone scaffold

cancellous allograft

422
Q

autografts

A

from pelvis

inductive and conductive

423
Q

allografts

A

only conductive and carry infection risk

424
Q

synthetic substitutes

A

inductive and conductive but expensive

425
Q

demineralized bone matrix

A

inductive only

426
Q

BMPs

A

inductive only

427
Q

intra-articular fracture

A

involves joint surface
needs perfect reduction
early motion key

428
Q

pro casting

A

undisturbed fracture milleu
no incisions
heals by endochondral ossification

429
Q

cons casting

A

no anatomic reduction

stiffness

430
Q

traction pro

A

does not disturb fracture

no risk of surgey

431
Q

traction con

A

poor reduction
pin site problems
fracture disease-bed sores, blood clots

432
Q

external fix pro

A

load bearing
small incisions
fracture milleu ok
early motion

433
Q

cons external fix

A

pin sites

434
Q

IM pro

A

load bearing
small incisions
periosteal blood supply ok
stimulates endosteal blood supply

435
Q

IM con

A

not anatomic
callus formation
too much movement

436
Q

ORIF pro

A

anatomic reduction
load sharing
early motion
heals wit hintramembranoous ossification-undif cells become osteoclasts and lay down new osteoid

437
Q

con ORIF

A

stripping increases nonunion

bigger wounds

438
Q

ORIF locked pro

A 
load bearing
internal exfix
early mostion
less stripping of periosteum
smaller wounds
good for poor bone quality
439
Q

cons ORIF locked

A

decreased healing due to lack of micromotion
cost
not anatomic reduction

440
Q

weight bearing status

A

quicker return to function and stimulate growth bone

but more weight than fix can handle is not good

DT1 Exam 2 (6 decks)

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